‘Biopsychosocial’ checks for patients with depression
By Liz Lockhart
New proposal indicators have been approved for development by the Quality Outcome Framework (QOF). You can learn more about QOF indicators at the end of this report. Under the new proposals GPs will have to review all patients with depression within a month of diagnosis and make a ‘biopsychosocial’ assessment. The assessment will include such things as the patient’s living conditions and social support.
Two indicators have been approved for development for next year’s QOF by a NICE QOF Committee during a meeting last week. These changes would massively extend the checks in patients with depression but they need to be given the go-ahead by the BMA and NHS Employers. Given the high profile that mental health has had over the last week, with a report from the Mental Health Policy Group that outlines the scandalous neglect that the NHS has heaped on mental illnesses and the Mental Health Debate in the House of Commons, dare we hope that this will meet with the required approval?
Under the proposed indicators, GPs will receive points for reviewing recently-diagnosed patients with depression within 10-35 days. They would also require GP practices to make a full ‘biopsychosocial’ assessment as part of the diagnosis of depression and to review the diagnosis again within three months.
There would be 16 ‘themes’ in the biopsychosocial analysis which include the patient’s symptoms, any use of alcohol and/or substance, suicidal ideation and any family history of mental illness. GPs will also have to look at other aspects of the patients life, such as interpersonal relationships, an assessment of social support, their living conditions, whether they have any employment or financial worries and discuss treatment options with them.
GPs have already been critical of the new proposals saying that they would make primary care responsible for solving social problems. The proposals have already been piloted in 30 practices throughout England and were considered to be favourable. However, only a third of the pilot practices felt that the impact on their workload would be minimal.
More practices will pilot the scheme for the QOF during 2013/14 after which the committee will look at them again in their next meeting in December.
The Quality and Outcomes Framework is a voluntary annual reward and incentive programme for all GP surgeries in England. It is not about performance management but resourcing and then rewarding good practice.
The QOF gives an indication of the overall achievement of a surgery through a points system. Practices aim to deliver high quality care across a range of areas for which they score points. Put simply, the higher the score, the higher the financial reward for the practice. The final payment is adjusted to take account of surgery workload and the prevalence of chronic conditions in the practice's local area.